this study will be conducted To determine the effect of vestibular rehabilitation training on postural sway and energy expenditure in children with spastic cerebral palsy and To determine any relation between postural sway and energy expenditure in children with spastic cerebral palsy.
The age of the selected children will be ranged from 8 to 12 years old.
Degree of spasticity is ranging from 1+to 2 according to modified Ashworth scale
The level of motor function of the children will be levels I-II according to Gross Motor Function Classification System
They are able to follow instructions and understand commands.
Bone and tendon lengthening surgeries within last 6 months.
Lung and heart diseases and disorders.
Vision or hearing problems
Children with fixed deformities.
Parallel
vestibular rehabilitation
Other intervention* Bouncing-jumping activities from standing. * linear swinging activities: using swinging platform (standing walking) scooter activity (kneeling, standing), hanging lower limb activities and climbing swinging robe ladder. * By pushing-pulling activities, displacement of the center of gravity is created. * These are activities which enable active equilibrium on steep surfaces such as stairs. * Walking on ramps. * Walking unfamiliar surfaces such as balance disc, balance boards and balance beam
conventional physical therapy
Other intervention* Balance exercise. * Gait training (forward, backward and side way). * Gait training with obstacles of different sizes. * Gait training in stepper. * Gait training on wooden ramp. * Gait training on balance board. * Training up and down steps different heights. * Stretching exercise for upper limbs and lower limbs. * Strengthening exercises for lower limbs muscles. * Trunk control exercises like abdominal and back exercises.
assessment of postural sway
The process for measuring frontal plane lateral trunk tilt angle during gait involves several steps as per the studies. First, three circular adhesive dots are placed on the sternal notch and the anterior superior iliac spine. A video camera is set up to capture the child's full body while walking. The recorded video is analyzed using Kinovea, dividing the gait cycle into 11 frames at 10% intervals. The angle of trunk deviation from vertical is calculated in these frames by connecting the anterior superior iliac spine markers and the sternal notch to determine the longitudinal axes of the trunk, with the angle measured against a vertical line.
assessment of Energy Expenditure
Heart rate expressed per distance walked provides information on energy economy as dose oxygen uptake expressed per distance walked because resting heart rate is known to increase with decreased body size and level of fitness, the resting heart rate is subtracted from the walking heart rate, and this value is divided by the walking speed. The following calculation of an energy expenditure index (energy expenditure index; beats/minute) energy expenditure index heart rate = (exercise heart rate-resting heart rate)/speed measured in m·min
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